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1245228790

NPI Code Detail

MEDICARE: MR. MAURY RUBEN ELLENBERG MD

MEDICARE: MR. MAURY RUBEN ELLENBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	4301034191	MI
2	208VP0000X	Pain Medicine Physician	4301034191	MI
3	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	4301034191	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245228790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAURY RUBEN ELLENBERG MD

Provider Business Mailing Address
First Line	:	6676 SOLUTIONS CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6006
Country	:	US
Telephone Number	:	248-893-3220
Fax Number	:	248-893-2950

Provider Business Practice Location Address
First Line	:	28455 HAGGERTY RD
Second Line	:	SUITE 200
City	:	NOVI
State	:	MI
Zip	:	48377-2982
Country	:	US
Telephone Number	:	248-893-3200
Fax Number	:	248-893-2950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	12/29/2015

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1427046952 — ELIZABETH M HALL MD
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1417945965 — DR. JEANETTE GLUSZEWSKI -SAUER MD
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1760470215 — MS. SUSAN JOYCE FRIEDMAN PA
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Directions to “ MR. MAURY RUBEN ELLENBERG MD” Practice Location

Language	Start Address	Practice Location

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